In one such study if the results were applied to the total population the cost of the particular drug would be over half of the total health budget of that country!

What is the answer?

With the advent of newer risk factors together with the final recognition of the importance of increasing HDL in the prevention of coronary artery disease (even when LDL cholesterol is normal) perhaps some sanity into preventive cardiology may come.

Unfortunately there is no financial gain in life-style change for the Multinational Pharmaceutical Houses – indeed there is the very real possibility of a reduced market for lipid lowering agents.

Governments whilst mouthing platitudes about the importance of exercise, diet, responsible alcohol consumption, smoking and the like are reluctant to dedicate financial support to these ventures.

The health improvement which will be obtained and the consequent savings in medical costs particularly in chronic diseases and hospitalisation are not instantaneous and in all probability in Western Society the government concerned may not be in power.

Recently the Queensland Government introduced a series of television commercials with the object of advancing the cause of eating more fruit and vegetables to the tune of two fruits and five vegetables per day.

Scant respect, if any, was paid to the financial cost of a family of four initiating such a change in eating habits.

My Cardiac Nurse took a visit to a supermarket and fruit store and averaged the price of conforming to the recommendations at a cost of $3.72/day/.person which equals for the family a weekly cost of $104. Hardly a proposition in today’s economic climate!

In fact physical inactivity has been shown to be a greater cause of morbidity and mortality than low fruit and vegetable diet . The cost of three Neocardial Walks/ week is simply cost of the patient’s time.

Whilst the single most beneficial action is to move the sedentary patient into the mild activity Group, if we wish to improve lifestyle and subsequently reduce the financial burden of chronic disease it is necessary to increase the level of activity further.

What Level of Exercise?

Exercising at or above the anaerobic threshold has been shown to be the most appropriate level to improve cardio-respiratory function.

Major problems with exercising at this level for protracted periods are the development of a metabolic acidosis.

Under a state of metabolic acidosis the myocardium does not respond to endogenous or exogenous catecholamines.

Hypokalaemia by the transfer of potassium into the cells promotes dysrhythmia.

Patients with acute myocardial ischaemia develop a metabolic acidosis commensurate with the severity of the ischaemia .

Neocardial Exercise by providing a specific individual exercise prescription allows the patient to exercise at sufficient level to ensure cardiac training effect without developing any significant metabolic acidosis.

This form of exercise can be undertaken irrespective of the patient’s physical condition or level of obesity with improvements in all parameters with results comparable with those fitter and lighter. A Paper submitted for Website Publication September 2006

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